NU142- Chapter 64: Assessment and Management of Patients With Hearing and Balance Disorders

Which of the following is the treatment of choice for acoustic neuromas?

Surgery

The nurse is examining the area behind the patient's auricle and sees a flaky scaliness. What disorder does the nurse suspect the patient has?

Seborrheic dermatitis

A client has a history of hearing loss and is returning for an annual hearing examination. During client education, the nurse explains that hearing involves which areas of the ear?

all sections

dizziness

altered sensation of orientation in space

rhinorrhea

drainage from the nose

If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone, causing

facial nerve paralysis.

myringotomy

incision in the tympanic membrane

A client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction?

"Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days."

Which statement describes benign paroxysmal positional vertigo (BPPV)?

The vertigo is usually accompanied by nausea and vomiting; generally, however, hearing is not impaired.

During a pharmacology class, the students are told that some drugs need to be closely monitored. What aspect should the nurse closely monitor for in clients who have been administered salicylates, loop diuretics, quinidine, quinine, or aminoglycosides?

Tinnitus and sensorineural hearing loss

vertigo

illusion of movement in which the individual or the surroundings are sensed as moving

acute otitis media

inflammation in the middle ear lasting less than 6 weeks

external otitis

inflammation of the external auditory canal

labrynthitis

inflammation of the labyrinth of the inner ear

nystagmus

involuntary rhythmic eye movement

conductive hearing loss

loss of hearing in which efficient sound transmission to the inner ear is interrupted by some obstruction or disease process

sensorineural hearing loss

loss of hearing related to damage to the end organ for hearing or cranial nerve VIII, or both

deafness

partial or complete loss of the ability to hear

presbycusis

progressive hearing loss associated with aging

You are teaching a class on diseases of the ear. What would you teach the class is the most characteristic symptom of otosclerosis?

A progressive, bilateral loss of hearing

Which of the following tests uses a tuning fork between two positions to assess hearing?

Rinne

A nurse is asked to assess a patient's need for a hearing aid. The nurse knows that a general guideline to determine need would be a hearing loss of:

40 dB in the range of 500 to 2,000 Hz.

A dietary modification for a patient with Ménière's disease would be:

A decrease in sodium intake to 2,000 mg daily.

The nurse is teaching a class on diseases of the ear. What would the nurse teach the class is the most characteristic symptom of otosclerosis?

A progressive, bilateral loss of hearing

The nurse caring for a client with Ménière's disease needs to assist with what when the client is experiencing an attack?

ADLs

A nurse is preparing a plan of care for a client with otitis externa. Based on the typical assessment findings, which of the following would the nurse most likely identify as the priority nursing diagnosis?

Acute pain related to inflammation

The nurse is caring for an 86-year-old client with hearing impairment. The nurse is preparing to educate the client on the diagnosis and discharge plan. What action(s) should the nurse take when talking with the client? Select all that apply.

Always face the client when talking. Provide written instructions and information.

High doses of which medication can produce bilateral tinnitus?

Aspirin

A client newly diagnosed with otitis media reports that the pain and pressure in the ear has suddenly disappeared. What is the best action by the nurse?

Assess the tympanic membrane.

The nurse is instructing a client's family members on the most incapacitating symptom of Ménière's disease. Which nursing instruction associated with the symptom is most helpful?

Assist the client when ambulating.

A client you are caring for has a hearing loss. The client tells you he is self-conscious about his hearing loss. What advice should the nurse give a self-conscious client with hearing loss to protect his self-esteem?

Be forthright and inform others about the hearing deficit.

The physician suggests that a client use meclizine as treatment for his motion sickness. The nurse explains the rationale for this drug based on an understanding of which of the following as the drug's action?

Blocks conduction of the vestibular pathways

Which of the following brain structures is responsible for equilibrium?

Cerebellum

Which is a correct rationale for encouraging a client with otitis externa to eat soft foods?

Chewing may cause discomfort.

Which nursing goal is a priority when caring for a client newly diagnosed with vertigo?

Client will remain safe while ambulating in the home.

The nurse is caring for a client experiencing hearing loss. The nurse uses the otoscope to assess the ear canal and tympanic membrane and notes a significant accumulation of cerumen. Which documentation of hearing loss type would be most accurate?

Conductive

Health teaching for a patient who suffers from motion sickness would include recommending the use of which one of the following over-the-counter drugs?

Dramamine

Which action by the nurse has the highest priority when caring for a client diagnosed with vertigo?

Educate the client on using the call light for assistance with ambulation.

A nurse is reviewing a client's medication history. Which drug would the nurse identify as placing the client at risk for ototoxicity.

Erythromycin

The nurse is caring for a client who just returned from a trip requiring an airline flight. The client commented on how his ears hurt upon descent. The nurse is correct in stating which site as being the pressure equalizer in the ear?

Eustachian tube

The nursing student hopefuls are taking a pre-nursing anatomy and physiology class. What will they learn is the anatomical feature that equalizes air pressure in the middle ear?

Eustachian tube

A nurse is performing an otoscopic examination on a client. Which finding would the nurse document as abnormal?

External auditory canal erythema

If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone causing which of the following?

Facial nerve paralysis

Which precautions should the nurse take when a client is at risk of injury secondary to vertigo and probable imbalance?

Grasp the siderails when rising to a standing position.

Which precaution should the nurse take when a client is at risk of injury secondary to vertigo and probable imbalance?

Have the client wait for help before moving

The client is having a Weber test. During a Weber test, where should the tuning fork be placed?

In the midline of the client's skull or in the center of the forehead

A nurse practitioner in an emergency room receives a telephone call from a mother whose 4-year-old child has a mosquito stuck in his external ear canal. Which of the following is the best information the nurse could give the mother?

Instill a few drops of warmed mineral oil to cover the insect.

A client comes to the walk-in clinic complaining of a "bug in my ear." What action should be taken when there is an insect in the ear?

Instillation of mineral oil

The nurse is developing a plan of care for a client with Meniere's disease and identifies a nursing diagnosis of excess fluid volume related to fluid retention in the inner ear. Which intervention would be most appropriate to include in the plan of care?

Limit foods that are high in sodium.

A patient is participating in aural rehabilitation. The nurse understands that this type of training emphasizes which of the following?

Listening skills

Hearing aids help with which of the following problems?

Makes sounds louder

The nurse is caring for a patient with Ménière's disease who is hospitalized with severe vertigo. What medication does the nurse anticipate administering to shorten the attack?

Meclizine (Antivert)

The nurse is caring for a client with recurrent ear infections. The nurse assesses the client for further infectious processes traveling deeper into the tissue and becoming more lethal. Which infection, originated in the ear, is of most concern?

Meningitis

A client comes to the emergency department, reporting that a bee has flown into his ear and is stuck. The client reports a significant amount of pain. Which of the following would be most appropriate to use to remove the bee?

Mineral oil

Which of the following describes vertigo? Select all that apply.

Misperception of motion Spinning sensation Objects are moving around him or her

Which of the following is an involuntary rhythmic movement of the eyes that is also associated with vestibular dysfunction?

Nystagmus

What is located in the cochlea of the inner ear?

Organ of Corti

Which condition is characterized by the formation of abnormal spongy bone around the stapes?

Otosclerosis

The nurse is developing a plan of care for a patient with severe vertigo. What expected outcome statement would be a priority for this patient?

Patient will experience no falls due to balance disorder.

The nurse is performing an assessment of a patient's ears. When looking at the tympanic membrane, the nurse observes a healthy membrane. What should the appearance be?

Pearly gray and translucent

Which nursing suggestion would be most helpful to the client with recurrent otitis externa?

Place ear plugs into the ears before swimming

Which condition refers to hearing loss associated with degenerative changes?

Presbycusis

Which terms refers to the progressive hearing loss associated with aging?

Presbycusis

A client is newly diagnosed with otitis externa. Which information should the nurse teach the client before the client leaves the clinic?

Proper instillation of prescribed ear drops

Some clients with acoustic neuromas have vertigo. What is a priority nursing action for clients with vertigo?

Protect the client from injury.

A nurse is practicing within a pediatric medicine group. What can the nurse do to maintain hearing within the pediatric client base?

Reduce frequency and severity of ear infections.

The nurse is instructing the client with dried cerumen blocking the ear canal on potential methods to reduce symptoms. Which at-home methods of cerumen removal are discouraged?

Removing the cerumen by means of a cotton tip applicator

A client with Meniere's disease has a nursing diagnosis of risk for injury related to gait disturbances and vertigo. Which of the following would be most appropriate to include in this client's plan of care?

Sitting down at the first sign of feeling dizzy

A nursing instructor is preparing a class on air and bone conduction of sound. When describing the transmission of sounds by air conduction, which of the following would the instructor include?

Sounds travel through the external and middle ears.

A nurse is preparing to perform the whisper test to assess a client's gross auditory acuity. Which of the following would be most appropriate for the nurse to do?

Stand about 1 to 2 feet away from the ear to be tested.

Which phrase defines ossiculoplasty?

Surgical reconstruction of the middle ear bones

A client comes to the walk-in clinic complaining of an earache. The cause is found to be impacted cerumen. The client asks the nurse what he can do at home to soften hardened cerumen. What should the nurse recommend to a client to soften hardened cerumen?

Take nonprescription preparations.

The nurse is working in a long-term care facility. Which clues that the nurse notes suggest that the client is not hearing what the nurse said? Select all that apply.

The client does not want to be social. The client responds inappropriately. The client nods the head and smiles. The client withdraws from activity.

You are admitting a 30-year-old who has a hearing impairment. The client is accompanied by family members. What information would be important to ask the family members to help you care for your client?

The client's preferred method of communication

A patient comes to the clinic with some hearing loss. The physician is unable to observe the tympanic membrane due to the accumulation of cerumen. What intervention can the nurse provide so that observation can be made?

The nurse can instill a small amount of mineral oil into the canal and have the patient return for removal of the wax.

The nurse is doing discharge teaching with a client newly diagnosed with Ménière's disease. Why would the nurse advise a low-sodium diet to this client?

To reduce the production of fluid in the inner ear

Which term refers to surgical repair of the tympanic membrane?

Tympanoplasty

Acoustic neuromas are benign tumors of which of the following cranial nerves?

VIII

When caring for a client after ear surgery, what is an important aspect of nursing care?

Validate client's feelings of discomfort.

A client who comes to the ambulatory care facility states, "It feels like things are moving or spinning around me." The nurse interprets this as indicating which of the following?

Vertigo

The nurse is talking with a patient diagnosed with Ménière's disease about the patient's symptoms. What symptom does the patient inform the nurse is the most troublesome?

Vertigo

Which manifestation is the most problematic for the client diagnosed with Ménière disease?

Vertigo

The clinical manifestations of motion sickness are caused by an overstimulation in what system?

Vestibular

Which instructions regarding swimming should the nurse give to a client who is recovering from otitis externa?

Wear soft plastic earplugs.

A nurse needs to change a dressing on an abdominal wound for a patient who is hearing-impaired and whose speech is difficult to understand. Which of the following is the best approach for the nurse?

Write down the steps of the procedure for the patient to read before beginning the treatment.

otosclerosis

a condition characterized by abnormal spongy bone formation around the stapes

Meniere disease

condition of the inner ear characterized by a triad of symptoms: episodic vertigo, tinnitus, and fluctuating sensorineural hearing loss

During assessment for cranial nerve functions, the client closes the eyes and begins to fall to one side. Which cranial nerve alteration causes this response?

cranial nerve VIII

endolymphatic hydrops

dilation of the endolymphatic space of the inner ear the pathologic correlate of Ménière disease

otorrhea

drainage from the ear

middle ear effusion

fluid in the middle ear without evidence of infection

chronic otitis media

repeated episodes of acute otitis media causing irreversible tissue damage

otalgia

sensation of fullness or pain in the ear

exostoses

small, hard, bony protrusions in the lower posterior bony portion of the ear canal

A client has been diagnosed with otosclerosis. The nurse explains to the client that this is a common cause of hearing impairment among adults and is the result of a bony overgrowth of the:

stapes

tinnitus

subjective perception of sound with internal origin unwanted noises in the head or ear

ossiculoplasty

surgical reconstruction of the middle ear bones to restore hearing

tympanoplasty

surgical repair of the tympanic membrane

A client who has a lengthy history of progressive hearing loss is very forthright about the condition, and the nurse wants to develop a communication strategy for this client's hospital stay. Which communication strategy has proven to be the most effective?

the one the client will use

cholesteatoma

tumor of the middle ear or mastoid, or both, that can destroy structures of the temporal bone